Localization of a major susceptibility locus influencing preterm birth.

Preterm birth (PTB) is a complex trait, but little is known regarding its major genetic determinants. The objective of this study is to localize genes that influence susceptibility to PTB in Mexican Americans (MAs), a minority population in the USA, using predominantly microfilmed birth certificate-based data obtained from the San Antonio Family Birth Weight Study. Only 1302 singleton births from 288 families with information on PTB and significant covariates were considered for genetic analysis. PTB is defined as a childbirth that occurs at <37 completed weeks of gestation, and the prevalence of PTB in this sample was 6.4%. An ∼10 cM genetic map was used to conduct a genome-wide linkage analysis using the program SOLAR. The heritability of PTB was high (h(2) ± SE: 0.75 ± 0.20) and significant (P = 4.5 × 10(-5)), after adjusting for the significant effects of birthweight and birth order. We found significant evidence for linkage of PTB (LOD = 3.6; nominal P = 2.3 × 10(-5); empirical P = 1.0 × 10(-5)) on chromosome 18q between markers D18S1364 and D18S541. Several other chromosomal regions (2q, 9p, 16q and 20q) were also potentially linked with PTB. A strong positional candidate gene in the 18q linked region is SERPINB2 or PAI-2, a member of the plasminogen activator system that is associated with various reproductive processes. In conclusion, to our knowledge, perhaps for the first time in MAs or US populations, we have localized a major susceptibility locus for PTB on chromosome 18q21.33-q23.

Approaches to management of adenocarcinoma following colocystoplasty.

UNLABELLED: Primary adenocarcinoma of the urinary bladder is rare and more so is adenocarcinoma arising in an augmented colocystoplastic bladder. We present a case of adenocarcinoma developing in a urinary bladder after colocystoplasty which was managed by radical cystectomy with bilateral pelvic lymphadenectomy. The post-operative histopathology showed the lesion to be an Adenocarcinoma with spread to the pericolic lymphnodes and not the pelvic lymphnodes. There are no guidelines for bladder screening in these patients who appear to be at risk. Radical Cystectomy remains the treatment of choice. Though post op irradiation has been reported, its role is not clearly defined. Role of chemotherapy in the adjuvant setting is yet to be defined. Following this is the literature review and a discussion on Adenocarcinoma arising in a colocystoplastically augmented bladder. KEYWORDS: Adenocarcinoma, urinary bladder, cystoplastically augmented bladder, radical cystectomy.

Evaluation of ergocalciferol or cholecalciferol dosing, 1,600 IU daily or 50,000 IU monthly in older adults.

CONTEXT: Whether ergocalciferol (D(2)) and cholecalciferol (D(3)) are equally effective to increase and maintain serum 25-hydroxyvitamin D [25(OH)D] concentration is controversial. OBJECTIVE: The aim of the study was to evaluate the effect of daily and once monthly dosing of D(2) or D(3) on circulating 25(OH)D and serum and urinary calcium. DESIGN, SETTING AND PARTICIPANTS: In a university clinical research setting, 64 community dwelling adults age 65+ were randomly assigned to receive daily (1,600 IU) or once-monthly (50,000 IU) D(2) or D(3) for 1 yr. MAIN OUTCOME MEASURES: Serum 25(OH)D, serum calcium, and 24-h urinary calcium were measured at months 0, 1, 2, 3, 6, 9, and 12. Serum PTH, bone-specific alkaline phosphatase, and N-telopeptide were measured at months 0, 3, 6, and 12. RESULTS: Serum 25(OH)D was less than 30 ng/ml in 40% of subjects at baseline; after 12 months of vitamin D dosing, levels in 19% of subjects (n = 12, seven receiving daily doses and five monthly doses) remained low, despite compliance of more than 91%. D(2) dosing increased 25(OH)D(2) but produced a decline (P < 0.0001) in 25(OH)D(3). Substantial between-individual variation in 25(OH)D response was observed for both D(2) and D(3). The highest 25(OH)D observed was 72.5 ng/ml. Vitamin D administration did not alter serum calcium, PTH, bone-specific alkaline phosphatase, N-telopeptide, or 24-h urine calcium. CONCLUSIONS: Overall, D(3) is slightly, but significantly, more effective than D(2) to increase serum 25(OH)D. One year of D(2) or D(3) dosing (1,600 IU daily or 50,000 IU monthly) does not produce toxicity, and 25(OH)D levels of less than 30 ng/ml persist in approximately 20% of individuals. Substantial between-individual response to administered vitamin D(2) or D(3) is observed.

Space flight alters bacterial gene expression and virulence and reveals a role for global regulator Hfq.

A comprehensive analysis of both the molecular genetic and phenotypic responses of any organism to the space flight environment has never been accomplished because of significant technological and logistical hurdles. Moreover, the effects of space flight on microbial pathogenicity and associated infectious disease risks have not been studied. The bacterial pathogen Salmonella typhimurium was grown aboard Space Shuttle mission STS-115 and compared with identical ground control cultures. Global microarray and proteomic analyses revealed that 167 transcripts and 73 proteins changed expression with the conserved RNA-binding protein Hfq identified as a likely global regulator involved in the response to this environment. Hfq involvement was confirmed with a ground-based microgravity culture model. Space flight samples exhibited enhanced virulence in a murine infection model and extracellular matrix accumulation consistent with a biofilm. Strategies to target Hfq and related regulators could potentially decrease infectious disease risks during space flight missions and provide novel therapeutic options on Earth.

Time and motion study: a comparison of two photostimulable phosphor imaging systems used in dentistry.

OBJECTIVES: To compare two photostimulable phosphor (PSP) dental radiographic systems in terms of time efficiency in making full mouth intraoral X-ray surveys (FMS). METHODS: PSP systems compared were (1) DenOptix) (Kavo/Gendex, Des Plaines, IL) and (2) ScanX) (Air Techniques, Hicksville, NY). Twenty one FMS of a DXTRR) Manikin (Dentsply, Des Plaines, IL) were made with each of the systems. Time for each procedural step was determined using a stopwatch. Steps studied were: (1) plate erasure; (2) packaging; (3) positioning/exposure; (4) unpacking, loading processor, scanning; and (5) image transfer to virtual FMS mount. The first six test runs for each system were excluded to eliminate the learning curve period influencing results. An independent groups t-test was employed for statistical analysis. The a priori was set at P< or =0.05. RESULTS: The total time involved in producing a FMS was not proven to be statistically significant comparing DenOptix) and ScanX). The mean procedure time for DenOptix) was 31.2 min; for ScanX) it was 27.1 min. While the processing time with ScanX) (mean time: 3.9 min) was shorter than for DenOptix) (mean time =7.8 min), the opposite was true for the image transfer to FMS format with the time much shorter with DenOptix) using VixWin) software (mean time =2.0 min) compared with ScanX) using Vipersoft) (mean time =3.9 min). The differences between the systems for these two steps did prove to be statistically significant (P< or =0.05). CONCLUSIONS: Although the mean time to make a FMS was slightly shorter on average with ScanX) than DenOptix), this difference was not proven to be statistically significant (P>0.05) in terms of time efficiency in producing a FMS.

Impact of ambient lighting intensity and duration on the signal-to-noise ratio of images from photostimulable phosphor plates processed using DenOptix and ScanX systems.

OBJECTIVES: To evaluate the impact on photostimulable phosphor (PSP) image signal-to-noise ratio (SNR) of pre-scanning ambient lighting exposures. METHOD: PSP imaging plates (IPs) were exposed to different radiation exposures to achieve flat field images. The exposed IPs were subjected variously to visible light of different intensities (300, 150 or 20 lux) for durations ranging from < 10 s to 120 s. They were processed using laser scanners from two systems for further comparison (DenOptix versus ScanX). Histogram analysis was performed in each case and mean pixel value and its standard deviation were used as surrogates to assess SNR. Statistical methods applied included analysis of variance with Tukey honestly significant difference test for pair wise comparisons. The a priori alpha was set at P < or = 0.05. RESULTS: SNR decreased with increased duration and intensity of pre-scanning light exposure. Lower X-ray exposures resulted in decreased signal resulting in reduced SNR, and increased the need to reduce ambient lighting. No statistically significant differences were found comparing ScanX and DenOptix digital imaging systems in terms of SNR. CONCLUSION: Reduced ambient lighting is preferred for handling IPs prior to processing in the laser scanner.

Mechanisms of bacterial pathogenicity.

Pathogenic bacteria utilise a number of mechanisms to cause disease in human hosts. Bacterial pathogens express a wide range of molecules that bind host cell targets to facilitate a variety of different host responses. The molecular strategies used by bacteria to interact with the host can be unique to specific pathogens or conserved across several different species. A key to fighting bacterial disease is the identification and characterisation of all these different strategies. The availability of complete genome sequences for several bacterial pathogens coupled with bioinformatics will lead to significant advances toward this goal.

Three-dimensional tissue assemblies: novel models for the study of Salmonella enterica serovar Typhimurium pathogenesis.

The lack of readily available experimental systems has limited knowledge pertaining to the development of Salmonella-induced gastroenteritis and diarrheal disease in humans. We used a novel low-shear stress cell culture system developed at the National Aeronautics and Space Administration in conjunction with cultivation of three-dimensional (3-D) aggregates of human intestinal tissue to study the infectivity of Salmonella enterica serovar Typhimurium for human intestinal epithelium. Immunohistochemical characterization and microscopic analysis of 3-D aggregates of the human intestinal epithelial cell line Int-407 revealed that the 3-D cells more accurately modeled human in vivo differentiated tissues than did conventional monolayer cultures of the same cells. Results from infectivity studies showed that Salmonella established infection of the 3-D cells in a much different manner than that observed for monolayers. Following the same time course of infection with Salmonella, 3-D Int-407 cells displayed minimal loss of structural integrity compared to that of Int-407 monolayers. Furthermore, Salmonella exhibited significantly lower abilities to adhere to, invade, and induce apoptosis of 3-D Int-407 cells than it did for infected Int-407 monolayers. Analysis of cytokine expression profiles of 3-D Int-407 cells and monolayers following infection with Salmonella revealed significant differences in expression of interleukin 1alpha (IL-1alpha), IL-1beta, IL-6, IL-1Ra, and tumor necrosis factor alpha mRNAs between the two cultures. In addition, uninfected 3-D Int-407 cells constitutively expressed higher levels of transforming growth factor beta1 mRNA and prostaglandin E2 than did uninfected Int-407 monolayers. By more accurately modeling many aspects of human in vivo tissues, the 3-D intestinal cell model generated in this study offers a novel approach for studying microbial infectivity from the perspective of the host-pathogen interaction.

Msx1 is required for the induction of Patched by Sonic hedgehog in the mammalian tooth germ.

We have used the mouse developing tooth germ as a model system to explore the transmission of Sonic hedgehog (Shh) signal in the induction of Patched (Ptc). In the early developing molar tooth germ, Shh is expressed in the dental epithelium, and the transcripts of Shh downstream target genes Ptc and Gli1 are expressed in dental epithelium as well as adjacent mesenchymal tissue. The homeobox gene Msx1 is also expressed in the dental mesenchyme of the molar tooth germ at this time. We show here that the expression of Ptc, but not Gli1, was downregulated in the dental mesenchyme of Msx1 mutants. In wild-type E11.0 molar tooth mesenchyme SHH-soaked beads induced the expression of Ptc and Gli1. However, in Msx1 mutant dental mesenchyme SHH-soaked beads were able to induce Gli1 but failed to induce Ptc expression, indicating a requirement for Msx1 in the induction of Ptc by SHH. Moreover, we show that another signaling molecule, BMP4, was able to induce Ptc expression in wild-type dental mesenchyme, but induced a distinct expression pattern of Ptc in the Msx1 mutant molar mesenchyme. We conclude that in the context of the tooth germ Msx1 is a component of the Shh signaling pathway that leads to Ptc induction. Our results also suggest that the precise pattern of Ptc expression in the prospective tooth-forming region is controlled and coordinated by at least two inductive signaling pathways.

Free radical and antioxidant status in urban and rural Tirupati men: interaction with nutrient intake, substance abuse, obesity and body fat distribution.

Rapid growth in urbanisation and industrialisation causes exposure to toxicant pollution which may contribute to increased incidences of non-communicable diseases. The present study reports on plasma lipid peroxides (LPO), lymphocyte free radicals, antioxidants and DNA damage in relation to life-style, obesity and body fat distribution measures among 56 urban men and 45 age matched rural men. Significant increases in plasma LPO, free radical generation (superoxide anion and hydrogen peroxide), and DNA damage indicated by malondialdehyde (MDA) levels were observed in urban compared to rural men. In vitro assay of DNA damage showed a higher level of MDA in samples of urban men than those of rural men. There were no significant differences in antioxidant enzymes between urban and rural men. Neither body mass index nor fat distribution had a significant influence on free radical generation, while the habits of smoking and alcohol consumption were associated with increased levels of free radicals, plasma LPO and DNA damage and reduced levels of antioxidant enzymes such as glutathione-S-transferase (GST), superoxide dismutase (SOD) and catalase in urban men. Dietary energy and fat intakes were positively correlated with free radical generation. Both superoxide anion and hydrogen peroxide were positively correlated with LPO and DNA damage, and negatively correlated with antioxidant enzymes in urban men. The marked elevation of free radical generation, LPO, DNA damage and depletion in antioxidant levels in urban men may suggest that exposure to environmental toxicant pollution is a risk factor for oxidative damage. It was of interest in this study that, whilst BMI was not greater in urban than rural men, abdominal fatness was. Hypothetically, fat distribution could be altered by the process of oxidative damage if it altered regulation of metabolically active omental fat.

Longitudinal evaluation of polymorphonuclear leukocyte chemiluminescence in premature infants.

A chemiluminescence (CL) microassay was used to evaluate polymorphonuclear leukocyte (PMN) function in premature newborn infants longitudinally during a 2-month period and in healthy adult control subjects. At postnatal ages of 12, 26, 40 and 54 days the infants' mean peak CL activity was significantly lower than that of the adults. Infants with one or more low CL responses were more severely ill than those with normal CL activity. The infants with low CL responses had longer hospital stays and a higher frequency of serious infections, as well as more days of level 3 care, antimicrobial therapy, supplemental oxygen, assisted ventilation, and total parenteral nutrition. The PMN CL activity before, during, and after episodes of serious infection did not differ. In addition, a high frequency of depressed CL activity was observed at the time of infection. Our findings are consistent with previous studies suggesting that defective PMN oxidative metabolic responses are more common in neonates undergoing stress. Our results further suggest that defective PMN function may persist for the first 2 months of life and during the course of serious infection. Enhancement of PMN host defense may be an important strategy in the management of neonatal sepsis.

Transmission of genital mycoplasmas from mother to neonate in women with prolonged membrane rupture.

Colonization of the neonate with genital mycoplasmas occurs during passage through a colonized birth canal or in utero via contamination of the amniotic fluid. To define further the route of transmission we obtained cultures from the maternal vagina, the amniotic fluid and the neonatal pharynx in 131 mother-baby pairs. Sixty-six percent (33 of 50) of the corresponding amniotic fluids were colonized when the vagina was colonized with Mycoplasma hominis. When the amniotic fluid contained M. hominis, 26% (9 of 34) of the neonates were colonized. Sixty percent (66 of 110) of the corresponding amniotic fluids were colonized when the vagina was colonized with Ureaplasma urealyticum. When the amniotic fluid contained U. urealyticum, 32% (22 of 69) of the neonates were colonized. No neonates were colonized with M. hominis without prior colonization of both the vagina and the amniotic fluid. We conclude that colonization of the amniotic fluid is an important intermediate step in colonization of the neonate with genital mycoplasmas.

Neonatal serologic response at term to the genital mycoplasmas.

Genital mycoplasmas are frequently found in the amniotic fluid (AF) of women with ruptured membranes but are infrequent pathogens in the neonates born to these women. The serologic response to the genital mycoplasmas, Mycoplasma hominis and Ureaplasma urealyticum, was studied in 35 mother-baby pairs following term deliveries. Amniotic fluid and neonatal surface cultures were obtained in all cases, as were maternal and neonatal acute and convalescent sera. Despite significant maternal serologic response, there was essentially no neonatal response. Mothers with M. hominis in the AF were significantly more likely than those with negative cultures for M. hominis to exhibit IgG seroconversion and had significantly greater changes in IgG concentrations. Their infants, however, did not exhibit a significant seroresponse regardless of the AF and neonatal culture results. There was also a significant maternal seroresponse to U. urealyticum. However, this did not correlate with the presence of U. urealyticum in the AF. Significantly fewer neonates exhibited a seroresponse to U. urealyticum, again with no relation to culture results.

A randomized trial of intrapartum versus immediate postpartum treatment of women with intra-amniotic infection.

A randomized trial of intrapartum versus postpartum antibiotic treatment of women with intra-amniotic infection was conducted. Intra-amniotic infection was treated with ampicillin and gentamicin during labor (at the time of diagnosis) in 26 women and immediately after umbilical cord clamping in 19 women. Intrapartum treatment led to a lower incidence of neonatal sepsis (0 versus 21%; P = .03) and a shorter neonatal hospital stay (3.8 versus 5.7 days; P = .02) when compared with postpartum treatment. There were no significant differences in the microbiologic results, the gestational age, or the birth weight between the groups. Intrapartum-treated mothers had a shorter mean postpartum stay, a lower mean number of febrile days, and a lower mean peak postpartum temperature than did postpartum-treated mothers; these differences were all statistically significant (P = .05). The treatment of clinical intra-amniotic infection during labor results in improved outcome.

Luminol-dependent chemiluminescence microassay for phagocytic function.

A luminol-dependent chemiluminescence (CL) microassay was developed to measure phagocytic function of peripheral blood leukocytes. Buffy coats, obtained by centrifugation of only 100 microliter of whole blood, provided an enriched population of polymorphonuclear leukocytes (PMNs). The total reaction mixture, consisting of leukocytes-luminol-inducer (opsonized zymosan), was 450 microliter. Peak CL activity was seen 5 min after addition of inducer at 37 degrees C with cells tested within 60 min after collection. Tests to determine precision and reproducibility of the microassay gave a coefficient of variation of 8.5% and 11%, respectively. There was no significant difference between the mean peak CL values for 20 healthy adult donors compared to 14 premature neonates, however, the newborns' CL activity declined more rapidly; CL activity was severely depressed in cells obtained from a patient with chronic granulomatous disease. Results suggest that this microassay provides a simple, rapid, and reliable test of phagocytic function in cases where the amount of blood available for testing is limited.

A comparison of intrapartum versus immediate postpartum treatment of intra-amniotic infection.

There are no reported randomized trials to determine the ideal timing of antibiotic treatment for intra-amniotic infection. We evaluated the effect of intrapartum versus immediate postpartum treatment of intra-amniotic infection on maternal and neonatal morbidity and mortality. Two hundred fifty-seven women with clinically diagnosed intra-amniotic infection who had amniotic fluid cultures were evaluated. Patients received treatment with penicillin and gentamicin, but the timing of the treatment was determined at the physician's discretion. Most patients (82%) received intrapartum treatment; the remaining women (18%), mainly those with an anticipated short interval before delivery, received the same antibiotics immediately postpartum. As expected, the postpartum treatment group had a significantly shorter diagnosis-to-delivery interval (1.9 +/- 2.1 versus 4.7 +/- 4.3 hours; P less than .001) and a lower maximum temperature during labor (100.8 +/- 0.7 versus 101.0 +/- 0.8F; P = .038). The two treatment groups did not differ in distribution of low birth weight infants, frequency of maternal bacteremia, mode of delivery, or organisms isolated from the amniotic fluid. There were no differences in maternal outcome, but the incidence of neonatal sepsis was significantly lower in the intrapartum treatment group (2.8 versus 19.6%; P less than .001). Neonatal mortality from sepsis was also lower in the intrapartum treatment group (0.9 versus 4.3%), but this difference was not statistically significant. The reduced frequency of neonatal septicemia observed in the intrapartum-treated group might reflect early intrauterine therapy for the infected fetus.

Postnatal alteration in hematocrit and viscosity in normal and polycythemic infants.

This study was done to document postnatal alterations in hematocrit and viscosity in the first 18 hours of life in 99 full-term infants, to better understand the age-dependent variations in these measurements that may have a bearing on the diagnosis of neonatal polycythemia. The peripheral venous Hct was highest at 2 hours of age, and dropped to cord blood levels by 18 hours. The whole blood viscosity of peripheral venous samples did not change significantly with age. In infants with peripheral venous Hct greater than or equal to 64%, and therefore considered to have polycythemia, a similar postnatal variation in Hct level was seen. Only 38% of infants with Hct greater than or equal to 64% at 2 hours of age continued to have a high level beyond 12 hours of age. The viscosity level in these infants tended to follow that of the Hct. The mean +/- 2 SD viscosity values obtained from peripheral venous samples was much higher than the upper limits of viscosity used in previous studies in which cord blood viscosity was used as the norm. Cord blood Hct correlated better with peripheral venous Hct than with capillary hematocrit, and provided a noninvasive method for screening. These findings suggest that the postnatal variations in Hct should be taken into consideration in the diagnosis of neonatal polycythemia.

Operative closure of patent ductus arteriosus in premature infants in the neonatal intensive care unit.

Fifty-two premature infants underwent hemoclip closure of patent ductus arteriosus in the neonatal intensive care unit after a brief trial of fluid restriction and diuretics. Indomethacin was used in only four patients. The median time from diagnosis to operation was 3 days. There were no deaths directly attributable to operation. Nine operative complications developed in nine patients (17 percent). There were no surgical infections. Complications related to prematurity resulted in 20 deaths (38 percent). Patent ductus arteriosus closure in the neonatal intensive care unit prevented the complications of hypothermia, inadvertent extubation, and interruption of vascular access and monitoring. Early operative closure in the neonatal intensive care unit is the treatment of choice in most premature infants with patent ductus arteriosus.

Cohort study of Silastic obstetric vacuum cup deliveries: II. Unsuccessful vacuum extraction.

In a cohort analysis of Silastic vacuum extractor deliveries, 65% were completed with the vacuum extractor alone, 24% with outlet forceps, 3% with midforceps, and 7% with cesarean section (vacuum extractor-cesarean). Control groups were formed by using the next sequential forceps delivery, spontaneous vaginal delivery, and every second cesarean section after a trial of labor. The infants were examined using a neurobehavioral scale, an encephalopathy assessment, cranial ultrasound, and indirect ophthalmoscopy. In the combined vacuum extractor and forceps delivery subgroup (vacuum extractor-forceps), all but 3% were converted from a high mid-forceps delivery to outlet forceps by the initial vacuum extractor procedure, thus eliminating many difficult midforceps deliveries. The study yielded no significant difference in maternal morbidity between vacuum extractor-forceps and forceps delivery, no difference in vaginal trauma for vacuum extractor-cesarean versus vacuum extractor delivery, and no greater hospital stay, infection rate, or need for transfusion for either vacuum extractor-forceps versus forceps delivery or vacuum extractor-cesarean versus cesarean delivery. Neonatal morbidity did not differ between successful and unsuccessful trial of vacuum extractor, except for an increased frequency of retinal hemorrhage. The frequency of scalp trauma, including cephalohematoma, did not differ between vacuum extractor-forceps and forceps delivery, or between vacuum extractor-cesarean and vacuum extractor delivery. For vacuum extractor-forceps versus forceps delivery and vacuum extractor-cesarean versus cesarean section, there were no significant differences in neurobehavioral or encephalopathy scores, or in the frequency of neonatal jaundice, facial palsy, anemia, fractures, or mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Cohort study of silastic obstetric vacuum cup deliveries: I. Safety of the instrument.

A prospective study was undertaken to determine the safety of the Silastic vacuum extractor. Between November 1982 and July 1983, a cohort of 84 successful vacuum extractor deliveries was examined, using the next sequential forceps delivery and spontaneous vaginal delivery as controls. In addition to routine neonatal morbidity measures, Scanlon early neonatal neurobehavioral scale and a modified Sarnat encephalopathy staging examination were used to critically assess neurologic functioning; a cranial ultrasound scan was performed to look for intracerebral hemorrhage, and an indirect ophthalmologic examination was done to assess the incidence of retinal hemorrhage. The study yielded no significant increase in maternal vaginal trauma for vacuum extractor versus spontaneous vaginal delivery, but there was a significantly greater incidence for forceps delivery (60%) versus vacuum extractor (25%) and more associated blood loss for forceps delivery (P less than .01). There was no significant increase in neonatal morbidity for vacuum extractor compared with forceps delivery nor in serious morbidity compared with spontaneous vaginal delivery. Specifically, for vacuum extractor versus forceps delivery there was no difference in one- and five-minute Apgar scores, extent of resuscitation, cosmetic injury, jaundice, mean neonatal intensive care unit stay, or incidence of retinal hemorrhage. Notably, there was no mortality related to delivery method, but there were two unrelated deaths. There were no cases of intraventricular or subgaleal hemorrhage on clinical or ultrasound examination, but one stillborn infant, who succumbed to a generalized coagulation defect, had a subarachnoid hemorrhage. Finally, there was no significant difference in Sarnat encephalopathy staging or Scanlon neurobehavioral assessment between spontaneous vaginal, forceps, and vacuum extractor deliveries.(ABSTRACT TRUNCATED AT 250 WORDS)